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Diniz SB, Meer E, Nesemann JM, Jackson NJ, Rootman DB. Head rotation and the perception of eyelid height and contour. BMJ Open Ophthalmol 2024; 9:e001557. [PMID: 38575344 PMCID: PMC11002378 DOI: 10.1136/bmjophth-2023-001557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Effective visual perceptual processing is one of the many components of surgical competence. Human face identification is most efficient when viewed upright. However, it is not yet clear how this perception sensitivity impacts eyelid symmetry. This study investigates surgeons' and laypeople's accuracy and efficiency in perceiving eyelid asymmetry from different spatial perspectives. METHODS A prospective psychometric experiment was conducted where oculoplastic surgeons were recruited from the American Society of Ophthalmic Plastic and Reconstructive Surgery and the Brazilian Oculoplastic Surgery Society, and control participants were recruited via crowdsourcing (Amazon's Mechanical Turk). Standard illustrations of the human face with varying degrees of eyelid abnormality, laterality, gender and rotation were presented to participants who were asked to judge whether the eyelids were symmetric or asymmetric. RESULTS The survey was completed by 75 oculoplastic surgeons (49.33% male; mean age of 46.9±10.7) and 192 lay individuals (54.6% male; mean age 34.6±11.3 years). Among oculoplastic surgeons, deviation from upright was significantly associated with increased reaction time and decreased proportion correct (OR per 45° for peak 0.68, 95% CI 0.60 to 0.77, p<0.001; OR per 45° for ptosis 0.52, 95% CI 0.32 to 0.87, p=0.012; OR per 180° for aggregate responses 0.56, 95% CI 0.51 to 0.61, p<0.001). Oculoplastic surgeons demonstrated increasing accuracy and decreasing reaction time with additional trials for both peak and ptosis. CONCLUSION Oculoplastic surgeons perceive eyelid asymmetries more accurately and can better compensate for inverted sensory information. However, accuracy increases and reaction time decreases with additional trials, suggesting trainability and potential for improvement in inversion disability.
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Affiliation(s)
- Stefania B Diniz
- Department of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| | - Elana Meer
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - John M Nesemann
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Nicholas J Jackson
- Statistics Core, University of California David Geffen School of Medicine, Los Angeles, California, USA
| | - Daniel B Rootman
- Department of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
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Cale M, Roelofs KA, Goldberg RA, Leibowitz S, Glasgow BJ, Rootman DB. Hyperostosis associated with orbital vascular malformation. Orbit 2024; 43:236-239. [PMID: 35850633 DOI: 10.1080/01676830.2022.2101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
A previously healthy adult male presented with a slowly enlarging orbital mass associated with 5 mm of non-pulsatile proptosis. On imaging, a soft tissue lesion with avid contrast enhancement and associated bony hyperostosis was noted. The lesion and hyperostotic bone were surgically debulked, and significant arterial bleeding was noted intraoperatively consistent with an arteriovenous malformation. Histopathologic analysis revealed a vascular malformation with enhanced microvasculature infiltrating the periosteum. While vascular lesions elsewhere in the body can be associated with skeletal changes, bony hyperostosis is a rare feature of orbital vascular malformations.
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Affiliation(s)
- Mario Cale
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Steven Leibowitz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Ben J Glasgow
- Departments of Ophthalmology and Pathology and Laboratory Medicine, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
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Goodyear K, Roelofs KA, Su-Velez BM, Cohen LM, Vadehra K, Beswick DM, Rootman DB. A Minimally Invasive Endoscopic Transnasal and Transorbital Approach to Sinonasal Tumor Resection. Laryngoscope 2024; 134:1308-1312. [PMID: 37606271 DOI: 10.1002/lary.30960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
A 35-year-old female with an extensive biphenotypic sinonasal sarcoma (BSNS) eroding through the left frontal sinus into the orbit required gross total resection of the tumor. We wanted to forgo an open approach and provide a less invasive alternative via combined endonasal and transorbital endoscopic techniques to allow for tumor removal through small, well-disguised incisions. We utilized three portals-nasal, transorbital, and anterior table window-to create interconnected orbit-sinonasal corridors, thus generating alternate pathways for visualization and manipulation of this extensive tumor. Laryngoscope, 134:1308-1312, 2024.
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Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Brooke M Su-Velez
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kumkum Vadehra
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, California, U.S.A
| | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Osias EA, Roelofs KA, Leibowitz S, Goldberg RA, Rootman DB. Transorbital Endoscopic Approach to the Pterygopalatine Fossa: A Less Invasive Alternative to Traditional Access. Ophthalmic Plast Reconstr Surg 2024; 40:223-226. [PMID: 37995150 DOI: 10.1097/iop.0000000000002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE The purpose of this article and accompanying video is to demonstrate a transorbital endoscopic approach for accessing the pterygopalatine fossa (PPF). This technique does not require a skin incision, avoids dissection of critical neurovascular structures, and utilizes a comparatively small osteotomy. The 2 cases presented in this article highlight the utility of a transorbital endoscopic approach for accessing an anatomic region that has traditionally required more invasive techniques to reach. METHODS Description of surgical technique with 2 illustrative clinical cases and accompanying surgical video. RESULTS Surgical technique: A trans-conjunctival approach is taken to the inferior orbital rim, and a subperiosteal dissection is propagated posteriorly. The bone of the posterior orbital floor is then deroofed, and the superior portion of the posterior wall of the maxillary sinus is removed, allowing access to the PPF for an incisional biopsy. CASE A 76-year-old male with a history of left cheek squamous cell carcinoma presented with progressive V2 paresthesia and an abnormally enhancing lesion in the left PPF on MRI. CASE A 58-year-old male with no significant medical history presented with left facial numbness (V1-V3), ptosis, an abduction deficit, and decreased hearing. Contrast-enhanced MRI demonstrated an abnormally enhanced lesion in the left PPF extending to Meckel's cave.The transorbital approach described was used to successfully obtain a diagnostic biopsy in both cases. CONCLUSIONS These cases highlight the utility of a transorbital endoscopic approach to the PPF as a less morbid alternative to traditional access. Patient selection is key to identifying appropriate cases.
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Affiliation(s)
- Ethan A Osias
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward JA. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2024; 40:230-232. [PMID: 38427838 DOI: 10.1097/iop.0000000000002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation
| | - Tanuj Nakra
- Department of Ophthalmology, Dell Medical School, TOC Eye and Face, Austin, Texas, U.S.A
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie A Woodward
- Oculofacial Cosmetic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Gundlach BS, Roelofs KA, Rootman DB. Inferior Oblique Flap: An Approach for Improved Vascular Supply in Complex Ocular Surface Reconstruction. Ophthalmic Plast Reconstr Surg 2024; 40:e56-e58. [PMID: 38215453 DOI: 10.1097/iop.0000000000002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
This case report describes a novel surgical technique using an inferior oblique muscle flap for a patient requiring complex ocular surface reconstruction. A 63-year-old female with Stevens-Johnson syndrome and complex ocular history including multiple penetrating keratoplasties and keratoprostheses presented with recurrent keratoprosthesis implant plate necrosis. In conjunction with revision keratoplasty, a custom inferior oblique muscle flap was designed to provide improved support and vascularity to the corneal tissue bed; at 12 months postoperation, the graft remained well attached and free of graft failure. Here, we present this technique along with operative photos, describing how this technique may provide surgeons an additional option for complex ocular surface reconstruction.
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Affiliation(s)
- Bradley S Gundlach
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Dallalzadeh LO, Villatoro GA, Chen L, Sim MS, Movaghar M, Robbins SL, Karlin JN, Khitri MR, Velez FG, Korn BS, Demer JL, Rootman DB, Granet DB, Kikkawa DO. Teprotumumab for Thyroid Eye Disease-related Strabismus. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00336. [PMID: 38319994 DOI: 10.1097/iop.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility. METHODS We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab. RESULTS Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation (p < 0.001), without significant change in mean horizontal deviation (p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye (p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion. CONCLUSIONS Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - George A Villatoro
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Lillian Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Myung S Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Mansoor Movaghar
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Shira L Robbins
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Justin N Karlin
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Monica R Khitri
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Federico G Velez
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
| | - Joseph L Demer
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, U.S.A.; and
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - David B Granet
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
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Osias E, Cale M, Saffari P, Barbosa Diniz S, Singh P, Rootman DB. Clinical and demographic predictors of buccal fat pad volume in thyroid eye disease. Orbit 2024; 43:58-63. [PMID: 36974465 DOI: 10.1080/01676830.2023.2192787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To understand how thyroid eye disease (TED) impacts buccal fat pad (BFP) volume. METHODS In this cohort study, computed tomography (CT) scans and charts of adult patients with and without TED were obtained from an institutional database. The primary outcome was BFP volume in cubic centimeters. Three independent, blinded observers analyzed scans using Horos, a free, open-source medical image viewing software. Bivariate and multivariable analyses were performed. We determined sample size using an effect size based on published reports of the minimum amount of fat excision needed to notice a clinical difference. Equivalence testing against upper and lower bounds set by the same effect size was conducted to assess practical significance of the results. RESULTS Our sample was sufficient to detect a difference as large as 1.5cc with 95% power. 72 scans were included in our study, 24 TED patients and 48 controls. Mean BFP volume was not statistically different between TED patients and controls (3.96 cc vs 4.06 cc, p = .778). Analysis of covariance adjusting for relevant patient factors (age, sex, and BMI) also failed to find a significant difference between groups. Equivalence testing was significant (p < .001) and revealed the observed difference between groups was less than any clinically meaningful difference. For an effect size of 1.5cc, the data suggests there is a 5% risk of a false negative. CONCLUSIONS TED was not associated with a significant difference in BFP volume, suggesting that the BFP is spared from TED-related soft-tissue expansion.
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Affiliation(s)
- Ethan Osias
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Mario Cale
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Persiana Saffari
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Stefania Barbosa Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Pallavi Singh
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
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Goodyear K, Ghiam S, Strawbridge J, Oh AJ, Singh P, Roelofs KA, Rootman DB. Prevalence, Clinical and Imaging Characteristics of Superior Ophthalmic Vein Periphlebitis in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00327. [PMID: 38285960 DOI: 10.1097/iop.0000000000002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
INTRODUCTION To determine the prevalence, clinical features, and radiographic findings of superior ophthalmic vein periphlebitis (SOVP) in thyroid eye disease (TED). METHODS Patients with a clinical diagnosis of thyroid eye disease and contrast-enhanced imaging were included. Imaging was reviewed for the presence of SOVP, and patients with SOVP were compared to those without. A random eye was determined to be the affected eye in patients without SOVP. RESULTS A total of 212 patients met the inclusion criteria. Unilateral SOVP was identified in 4.7% of cases. There was no significant difference in age (p = 0.22), gender (p = 0.09), or disease duration (p = 0.14) between patients with and without SOVP. There was a significant (p < 0.05) difference in stage classification and clinical activity core between the groups. The affected eye in patients with SOVP had significantly (p < 0.05) greater margin reflex distance 1, degree of relative proptosis, horizontal motility restriction, and vertical motility restriction than in patients without SOVP. There was no significant difference in horizontal strabismus (p = 1.0), vertical strabismus (p = 0.87), or relative intraocular pressure (p = 0.77). On imaging, the maximal diameter of the SR and IR were found to be significantly (p < 0.05) larger in the affected eye of patients with periphlebitis; however, there was no difference in measured diameter of the medial rectus and (p = 0.30) or lateral rectus (p = 0.78). CONCLUSIONS SOVP is an under-reported imaging finding of thyroid eye disease. It is associated with significantly greater margin reflex distance 1, relative proptosis, and motility restriction on exam as well as larger superior rectus and inferior rectus diameter on imaging. These patients tend to present in the active stage of disease with greater clinical activity score.
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Affiliation(s)
- Kendall Goodyear
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Sean Ghiam
- Department of Ophthalmology, Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Jason Strawbridge
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Angela J Oh
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Pallavi Singh
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Gu D, Cohen LM, Jung J, Rootman DB. Hemorrhage Following Muller's Muscle Conjunctival Resection: Description and Case-Control Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00328. [PMID: 38285959 DOI: 10.1097/iop.0000000000002605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
PURPOSE The purpose of this study was to report a series of patients with postoperative hemorrhage after Muller's muscle conjunctival resection surgery and compare risk factors and outcomes with a control population. METHODS In this case-control study, records of patients who underwent Muller's muscle conjunctival resection over 5 years were reviewed for a history of postoperative hemorrhage occurring >24 hours after surgery. A 4:1 control population was matched for age and sex. Clinical data collected included demographics, medical history, medications, and subsequent surgery. Preoperative and 3-month postoperative marginal reflex distance 1 were measured digitally using ImageJ. The hemorrhage and control groups were compared using Fisher's exact tests for categorical variables and independent samples t tests for continuous variables. RESULTS The hemorrhage group contained 10 patients (mean age 66.4 ± 18.5 years). The control group consisted of 40 age and sex-matched controls. Of 350 charts reviewed, there were 10 cases of postoperative hemorrhage (incidence 2.9%). Hemorrhage occurred a mean of 4.2 ± 1.3 (range 2-7) days after surgery and lasted for a mean of 29.3 ± 19.1 (range 12-72) hours. In all 10 cases, the bleeding resolved with conservative measures. There was no difference between the hemorrhage and control groups in terms of medical conditions, blood thinners, and surgical revision. Preoperative, postoperative, and change in marginal reflex distance 1 did not differ between the hemorrhage and control groups. CONCLUSIONS Hemorrhage occurs approximately 4-5 days postoperatively in a small percentage of patients undergoing Muller's muscle conjunctival resection surgery. This investigation did not identify any consistent risk factors, and outcomes in this patient population appear no different than controls.
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Affiliation(s)
- David Gu
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Liza M Cohen
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, U.S.A
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute
| | - JooYeon Jung
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute
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Roelofs KA, Juniat V, O'Rouke M, Ledbetter L, Hubschman S, Hardy T, Lee J, Baugh S, Pullarkat ST, Selva D, Goldberg RA, Rootman DB. Radiologic Features of Well-circumscribed Orbital Tumors With Histopathologic Correlation: A Multi-center Study. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00313. [PMID: 38215460 DOI: 10.1097/iop.0000000000002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE To delineate specific imaging characteristics of solitary fibrous tumors, schwannomas, cavernous venous malformations, and well-circumscribed orbital lymphoma. METHODS Patients undergoing excisional biopsy of solitary fibrous tumor, schwannomas, cavernous venous malformations, or well-circumscribed orbital lymphoma with preoperative MRIs available for review were identified at 3 academic centers in the United States and Australia. An exploratory statistical analysis was performed to identify important radiologic features, which were subsequently included in a random forest model. Histopathologic correlates were evaluated in representative cases. RESULTS A total of 91 cases were included with a mean age of 52.9 ± 17.2 years. Nearly all solitary fibrous tumors were located in the anterior or mid orbit (87.5%) and they more commonly demonstrated intralesional heterogeneity on T2-weighted imaging (45.5%) (p < 0.01). Compared with the other tumors, schwannomas tended to be intraconal (66.7%) and were often in the mid or posterior orbit (83.4%) (p < 0.01). Cavernous venous malformations characteristically demonstrated progressive contrast enhancement (93.9%; p < 0.01). Most lesions in all 4 groups were hypointense on T1-weighted imaging (80%-100%; p = 0.14) and only well-circumscribed orbital lymphoma tended to also be hypointense on T2 (81.8%) (p < 0.01). Finally, cases of lymphoma had significantly lower apparent diffusion coefficient ratios (0.9 ± 0.2) (p < 0.001), while the other 3 groups were not significantly different from one another (cavernous venous malformations: 1.8 ± 0.4; schwannomas: 1.8 ± 0.5; and solitary fibrous tumor: 1.6 ± 0.6) (p = 0.739). CONCLUSIONS Key features that aid in the differentiation of these 4 tumors from one another include T2 intensity and homogeneity, early contrast-enhancement pattern, and ADC ratio.
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Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael O'Rouke
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Luke Ledbetter
- Department of Radiology, University of California, Los Angeles, California, U.S.A
| | - Sasha Hubschman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Thomas Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Jean Lee
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Sheeja T Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Chen T, Roelofs KA, Baugh S, Esfandiari M, Rootman DB. Orbital Liposarcoma: A Surveillance, Epidemiology and End Results Database Study. Ophthalmic Plast Reconstr Surg 2024; 40:93-98. [PMID: 37695202 DOI: 10.1097/iop.0000000000002516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE Orbital liposarcoma is a challenging tumor to treat due to its rarity and high rate of local recurrence, and the role of radiotherapy and chemotherapy remain unclear. Analysis of big data may improve our overall understanding of orbital disease and role of adjuvant therapies. METHODS Data were extracted from the Surveillance, Epidemiology and End Results (SEER) Research Plus database from 1975 to 2017. All patients with a diagnosis of liposarcoma (ICD-O3 codes 8850-8858, 8869-8862, 8870, 8880, 8881) were included. Cases were divided into 4 groups by primary site: orbit, retroperitoneum, soft tissue, and other. RESULTS A total of 16,958 patients were included. Patients with orbital involvement were younger and more likely to be female ( p < 0.05). Among orbital lesions, myxoid liposarcoma was the most common histologic subtype (6/19; 31.6%) followed by well differentiated (5/19; 26.3%). This differed from the distribution of histologic subtypes encountered elsewhere, for which well-differentiated liposarcoma was the most common (retroperitoneum 979/3,136; 31%, soft tissue 3,493/11,671; 30%, and other sites 497/2,132; 23%, p < 0.05). Dedifferentiated histologic subtype was the second most common subtype found in the retroperitoneum (946/3,136; 30%), whereas it was less common in the orbit (2/19; 11%) and soft tissue (1,396/11,671; 12%) ( p < 0.001). Patients with orbital liposarcoma had similar disease-specific mortality compared with soft-tissue location ( p = 0.825) and lower disease-specific mortality compared with retroperitoneal location ( p < 0.001). When all locations were combined, patients with well-differentiated liposarcoma had the lowest disease-specific mortality. CONCLUSIONS Patients with orbital liposarcoma tend to be younger, female, and have a better prognosis than those with retroperitoneal disease, likely due to the lower incidence of dedifferentiated histologic subtype.
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Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Samuel Baugh
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Mahtash Esfandiari
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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13
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward JA. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2024; 40:118-120. [PMID: 38241626 DOI: 10.1097/iop.0000000000002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation Crown Center II, 5001 Rockside Rd, Independence, OH 44131
| | - Tanuj Nakra
- Department of Ophthalmology, Dell Medical School, TOC Eye and Face, Austin, Texas, U.S.A
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie A Woodward
- Oculofacial Cosmetic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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14
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Strawbridge JC, Roelofs KA, Naderi J, Goh TY, Rootman DB. Orbital manifestations of B-cell acute lymphoblastic leukemia/lymphoma. Orbit 2023; 42:654-658. [PMID: 35580237 DOI: 10.1080/01676830.2022.2072901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
A 2-year-old boy presented with left periorbital edema, proptosis, hyperglobus and esotropia. Imaging revealed an inferotemporal orbital mass with adjacent bony erosion. Histological evaluation of an orbital biopsy revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/BLL). The patient was subsequently treated with chemotherapy. Although orbital involvement in acute myelogenous leukemia has been well-described, orbital manifestations of B-ALL/BLL are uncommon, with only a limited number of previous reports in the literature.
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Affiliation(s)
- Jason C Strawbridge
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| | - Jason Naderi
- Rosalind Franklin University School of Medicine, North Chicago, Illinois, USA
| | - Tracie Y Goh
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
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15
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Oh AJ, Rootman DB. Recent Fluctuations in Public Searches for Cosmetic Procedures as Shown by Google Trends. Ophthalmic Plast Reconstr Surg 2023:00002341-990000000-00284. [PMID: 37972973 DOI: 10.1097/iop.0000000000002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The goal of this study is to understand the dynamic trends of 20 cosmetic procedures in the United States using Google Trends. METHODS This was a descriptive cross-sectional study using Google Trends to measure changes in search volumes for 20 cosmetic procedures from a 5-year period (2018 to 2023) in the United States. Outcome measures included total and weekly changes in relative search volumes and variance levels for the following 20 search terms related to cosmetic surgeries: blepharoplasty, botox, breast augmentation, breast lift, brow lift, buccal fat removal, chemical peel, dermal filler, face lift, hair removal, hair transplant, lip filler, liposuction, masseter botox, microneedling, otoplasty, photofacial, rhinoplasty, tear trough filler, and tummy tuck. Search terms were divided into 3 categories, a) those with a change of public interest over a single week of 25% or less, b) 26%-50%, and c) greater than 50%. RESULTS There was an overall 5-year increase of public interest in all but 5 search terms: breast augmentation, breast lift, liposuction, photofacial, and tummy tuck. Within a single week, lip filler, masseter botox, buccal fat removal, and tear trough filler exhibited greater than 50% change in public interest, while public interest in microneedling, hair removal, rhinoplasty, tummy tuck, liposuction, breast lift, and augmentation were more stable with less than 26% change. CONCLUSIONS While certain procedures may experience rapid accelerations in public interest, not all procedures will consistently increase in popularity. Physicians must recognize the shifting popularity of cosmetic procedures to provide informed cosmetic care to patients.
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Affiliation(s)
- Angela J Oh
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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16
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Hubschman S, Sojitra B, Ghiam S, Sears C, Hwangbo N, Goldberg RA, Rootman DB. Teprotumumab and Orbital Decompression for the Management of Proptosis in Patients With Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2023:00002341-990000000-00282. [PMID: 37972968 DOI: 10.1097/iop.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare outcomes of patients with thyroid eye disease treated with teprotumumab or orbital decompression, or both in sequence. METHODS Patients with thyroid eye disease and treated with decompression, teprotumumab, or both were included. Four groups were defined: decompression only, teprotumumab only, teprotumumab first with decompression later, and decompression first with teprotumumab later. The primary outcome was change in exophthalmometry. Secondary outcomes included change in extraocular muscle motility, strabismus, diplopia, and side effects. RESULTS One hundred and thirty-nine patients were included. The mean duration for early follow-up was 1.2 months for both decompression and teprotumumab groups. The mean late follow-up was 14.4 and 8.2 months for the decompression and teprotumumab groups respectively. Mean change in exophthalmometry was significantly greater for the decompression group (3.5 mm) compared with teprotumumab (2.0 mm) at late follow-up. Improvement in total extraocular muscle restriction was significantly greater in the teprotumumab group (14.7 degrees) than in the decompression group (2.6 degrees). The teprotumumab group had a significantly higher percentage of patients with diplopia score >1 at baseline and late follow-up (p < 0.01) compared with the decompression group. Additional treatment with teprotumumab or decompression when previously treated with the opposite had similar proptosis reduction effect as that therapy alone. CONCLUSIONS Surgical decompression has a greater proptosis reduction effect than teprotumumab, whereas teprotumumab better improves extraocular muscle motility. The addition of teprotumumab or decompression to a previous course of the opposite adds a similar effect to the supplemental treatment alone.
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Affiliation(s)
- Sasha Hubschman
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Badal Sojitra
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Sean Ghiam
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Connie Sears
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Nathan Hwangbo
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute
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17
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Ghiam S, Wang Y, Rootman DB. Re: "Lateral Rectus Muscle Expands More Than Medial Rectus Following Maximal Deep Balanced Orbital Decompression". Ophthalmic Plast Reconstr Surg 2023; 39:649. [PMID: 37922048 DOI: 10.1097/iop.0000000000002538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
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18
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2023; 39:650-652. [PMID: 37922049 DOI: 10.1097/iop.0000000000002535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Tanuj Nakra
- TOC Eye and Face, Austin, Texas, U.S.A
- Department of Ophthalmology, Dell Medical School, Austin, Texas, U.S.A
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie Woodward
- Oculofacial Cosmetic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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19
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Saffari PS, Diniz SB, Rootman DB. Lacrimal hyperalgesia: a case series of post-operative painful lacrimation. Orbit 2023:1-4. [PMID: 37798965 DOI: 10.1080/01676830.2023.2263892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
Lacrimal hyperalgesia is a rare type of periorbital neuralgia triggered by tear production. Two female patients in their mid-forties underwent orbital surgery and, several weeks following their procedures, developed pain when they produced tears. The symptom was described as a sharp, debilitating, and transient periocular pain. A possible mechanism for this lacrimal hyperalgesia is through the formation of an artificial synapse along the superolateral aspect of the orbit. Two mechanisms for this type of hyperalgesia are described herein, which include potential mechanical compression or direct disruption of the normal nerve pathways and microvascular disruption causing ischemic nerve injury. Currently, there is no accepted treatment for this aberrant neuropathic pain caused by lacrimation. Gabapentin therapy was trialed in one of these two patients, who experienced partial improvement with nightly use. In this case series, we describe the clinical and radiographic features associated with this unique type of neuralgia, emphasizing the importance of recognizing it as a complication following orbital surgery.
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Affiliation(s)
- Persiana S Saffari
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Stefania B Diniz
- Stein Eye Institute, Division of Orbital and Oculoplastic Surgery, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Stein Eye Institute, Division of Orbital and Oculoplastic Surgery, University of California, Los Angeles, California, USA
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20
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Goodyear K, Pirakitikulr N, Rootman DB. Punctal Plug Granuloma After Blepharoplasty. JAMA Ophthalmol 2023; 141:e232462. [PMID: 37855838 DOI: 10.1001/jamaophthalmol.2023.2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
This case report discusses a diagnosis of foreign body granuloma resulting from a punctal plug in a patient aged 66 years with chronic dry eye and a history of blepharoplasty.
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Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles
| | - Nathan Pirakitikulr
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles
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21
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Goodyear K, Saffari PS, Esfandiari M, Baugh S, Rootman DB, Karlin JN. Estimating apparent age using artificial intelligence: Quantifying the effect of blepharoplasty. J Plast Reconstr Aesthet Surg 2023; 85:336-343. [PMID: 37543022 DOI: 10.1016/j.bjps.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/28/2023] [Accepted: 07/08/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES Quantify the rejuvenation effect of blepharoplasty. METHODS A dataset of facial photographs was assembled and randomly split into 90% training and 10% validation sets. An artificial intelligence model was trained to input a facial photograph and output the apparent age of the depicted face. A retrospective chart review of patients who underwent blepharoplasty was used to assemble a test set-preoperative and postoperative photographs were culled and subsequently analyzed by the model. RESULTS A total of 47394 images of patients aged 26-89 years old were used for model training and validation. On the validation set, the model achieved 75% accuracy with a mean absolute error of 1.38 years and Pearson's r of 0.92. A total of 103 patients (29 males and 74 females) met the test set inclusion criteria (upper blepharoplasty n = 28, lower blepharoplasty n = 33, and quadrilateral blepharoplasty n = 42). The test set age ranged from 30.3 to 83.8 years old (mean 60.8, standard deviation 11.4). Overall, the model-predicted test set patients to be 0.74 years younger preoperatively versus 2.52 years younger postoperatively (p < 0.01). Significant underestimation of age was observed in women who underwent lower blepharoplasty (n = 23, 1.28 years older preoperatively vs. 2.32 years younger postoperatively, p = 3.8 × 10-4) and men who underwent quadrilateral blepharoplasty (n = 10, 0.71 years younger preoperatively vs. 5.34 years younger postoperatively, p = 0.02). CONCLUSIONS The deep learning algorithm developed in this study demonstrates that, on average, blepharoplasty provides a rejuvenating effect of approximately 2 years.
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Affiliation(s)
- Kendall Goodyear
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, CA, United States
| | | | | | - Samuel Baugh
- Department of Statistics, UCLA, Los Angeles, CA, United States
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, CA, United States
| | - Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, CA, United States.
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22
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Cohen LM, Ponce Mejia LL, Duckwiler GR, Goldberg RA, Rootman DB. External carotid artery to ophthalmic artery flow associated with internal carotid artery stenosis. Orbit 2023; 42:529-535. [PMID: 36469588 DOI: 10.1080/01676830.2022.2149818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease. METHODS In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved. RESULTS The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) (p < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow (p < .001). CONCLUSIONS ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.
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Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - L Luciano Ponce Mejia
- Division of Interventional Neuroradiology, Department of Radiology, University of California, Los Angeles, CA, USA
| | - Gary R Duckwiler
- Division of Interventional Neuroradiology, Department of Radiology, University of California, Los Angeles, CA, USA
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, CA, USA
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23
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2023; 39:519-521. [PMID: 37681710 DOI: 10.1097/iop.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation
| | - Tanuj Nakra
- Department of Ophthalmology, Dell Medical School, TOC Eye and Face, Austin, Texas, U.S.A
| | - Daniel B Rootman
- Department of Ophthalmology, Dell Medical School, TOC Eye and Face, Austin, Texas, U.S.A
| | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie Woodward
- Oculofacial Cosmetic and Reconstructive Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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24
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Cheng S, Roelofs KA, Pirakitikulr N, Rootman DB. Orbital Vascular Malformations: Relationship Between Enophthalmos and Clinically Apparent Distensibility with Valsalva. Ophthalmic Plast Reconstr Surg 2023; 39:487-491. [PMID: 36972118 DOI: 10.1097/iop.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE Determining the hemodynamic characteristics of an orbital vascular malformation is a critical step in management. The purpose of this study is to assess the relationship between enophthalmos and clinically apparent distensibility of orbital vascular malformations, to optimize imaging and treatment. METHODS In this cross-sectional cohort study consecutive patients at a single institution were screened for study entry. Data extracted included age, sex, Hertel measurements, presence or absence of distensibility during the Valsalva maneuver, whether lesions were primarily venous or lymphatic based on imaging, and location of the lesion relative to the globe. Enophthalmos was defined as ≥ 2 mm difference from the opposite side. Parametric and nonparametric statistics were used, and linear regression was performed to examine factors predictive of Hertel measurement. RESULTS Twenty-nine patients met the inclusion criteria. Relative enophthalmos ≥2 mm was significantly associated with distensibility ( p = 0.03; odds ratio = 5.33). Distensibility and venous dominant morphology were the 2 most important factors associated with enophthalmos on regression analysis. The relative position of the lesion anterior or posterior to the globe did not have a significant bearing on baseline enophthalmos. CONCLUSIONS The presence of enophthalmos increases the likelihood that an orbital vascular malformation is distensible. This group of patients was also more likely to be characterized by venous dominant malformations. Baseline clinical enophthalmos may serve as a useful surrogate marker for distensibility and venous dominance, which may be useful in guiding the selection of appropriate imaging.
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Affiliation(s)
- Sarah Cheng
- Department of Ophthalmology, Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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25
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2023; 39:400-402. [PMID: 37413685 DOI: 10.1097/iop.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tanuj Nakra
- Department of Ophthalmology, Dell Medical School, TOC Eye and Face, The University of Texas at Austin, Austin, Texas
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania
| | - Julie Woodward
- Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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26
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Chen TH, Roelofs KA, Goh T, Pullarkat S, Goldberg RA, Rootman DB. Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2023; 39:e107-e111. [PMID: 37083726 DOI: 10.1097/iop.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.
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Affiliation(s)
- Teresa H Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Tracie Goh
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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27
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Clark A, Souverein EA, Rootman DB, Yang D, Kreiger AE, Nagiel A. Macular Sling: A Customizable Method for Macular Buckling using Available Elements. Retin Cases Brief Rep 2023; Publish Ahead of Print:01271216-990000000-00172. [PMID: 37224475 PMCID: PMC10663378 DOI: 10.1097/icb.0000000000001438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Macular buckling surgery is used to treat certain cases of myopic traction maculopathy but is rarely performed in the United States. One of the main factors limiting its use is the lack of commercially available buckling elements. Here we describe a novel technique for creating an effective macular buckle using readily obtainable buckling materials. METHODS By using a traditional circumferential 41 band as the anchoring point around the globe, a 240 band can then be attached and oriented posteriorly along the superonasal-infertemporal axis. This posterior 240 band is then used to guide a grooved sponge (509G) under the macula to create a customizable and titratable tamponade effect along the posterior pole. This approach was used to provide external support in the case of a recurrent, complex tractional retinal detachment which had failed multiple prior vitrectomy-based repairs. RESULTS Placement of the macular sling resolved the patient's recurrent retinal detachment with return of visual acuity to her pre-operative baseline. There have been no adverse effects related to the surgery aside from a large hyperopic shift due to the buckle effect on the macula. We believe the technical and material complexity of this technique is comparable to that of more common scleral buckling techniques. CONCLUSIONS This macular sling technique can be used to create an effective posterior buckle without requiring specialized materials.
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Affiliation(s)
- Andrew Clark
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Erik A. Souverein
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Daniel B. Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA
| | - Dong Yang
- Retina Division, Department of Ophthalmology, University of Washington, Seattle, WA
| | - Allan E. Kreiger
- Retina Division, Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA
| | - Aaron Nagiel
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
- The Vision Center, Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, CA
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward JA. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2023; 39:299-301. [PMID: 37166293 DOI: 10.1097/iop.0000000000002404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Tanuj Nakra
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, TOC Eye and Face, Austin TX
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie A Woodward
- Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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OH ANGELA, Roelofs K, Karlin JN, Rootman DB. Orbitocranial penetration of ball bearing gun trauma: A prospective human cadaveric study. J Neurol Surg B Skull Base 2023. [DOI: 10.1055/a-2052-8668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Purpose: We completed a prospective human cadaveric study to determine the ability of a BB pellet to penetrate the orbit and/or surrounding structures.
Methods: A single trained sergeant officer discharged an alloy steel air rifle to eight cadaver orbits from four adult human cadaver heads. Five BB pellets each were aimed at three locations (caruncle, upper eyelid or lower eyelid) at ten cm and one meter, and then less specifically, at the orbital region for three- and five-meter distances. Computerized tomography of the cadaver heads was performed. Final locations of BB pellets divided into three categories: intracranial, surrounding orbital structures including the pterygopalatine fossa and infratemporal fossa, and orbit.
Results: 37 of 40 BB pellets penetrated soft tissue and were visualized on CT. 19 (51%) rested in the intracranial space, 17 (46%) in surrounding orbital structures, and one (3%) within the orbit. The deepest position of a pellet was in the parietal lobe, and most superficial location anterior to the frontal bone. Pellets discharged from 1m were more likely to rest in the intracranial space compared to those from 10cm (p<0.001), 3m (p=0.011), and 5m (p=0.004). The distance of discharge was associated with final pellet location (p=0.001).
Conclusions: BB guns should be considered dangerous and potentially deadly when aimed at the orbit. Although the thick calvarium can protect the intracranial space from BB penetration, the orbit may be a vulnerable entry point with relatively low-resistance, allowing penetration of the intracranial and periorbital spaces.
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Affiliation(s)
| | | | - Justin N. Karlin
- Doheny and Stein Eye Institutes, Division of Orbital and Oculoplastic Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, United States
| | - Daniel B. Rootman
- Doheny and Stein Eye Institutes, Division of Orbital and Oculoplastic Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, United States
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30
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Manta AI, Jackson NJ, Dan J, Tran A, Rootman DB. Effect of external eyelid weighting on eyelid and eyebrow position in normal and ptosis patients. Graefes Arch Clin Exp Ophthalmol 2023; 261:849-855. [PMID: 36112219 DOI: 10.1007/s00417-022-05825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to characterize the physiologic response of both eyelid and eyebrow position to increasing downward forces simulated by external weights. METHODS In this prospective observational study, both normal individuals and patients affected by ptosis were tested. External eyelid weights were placed on one upper eyelid with incrementally increasing weight from 0.2 to 2.4 g. The eyelid carrying the weight was randomly selected for normal subjects and patients with bilateral ptosis, whereas for unilateral ptosis, the ptotic eyelid was utilized. Photographs were obtained at baseline and with increasing weight until MRD1 reached 0 on the weighted side or, until 2.4 g was reached. Eyelid and brow position on the weighted and unweighted sides were digitally measured in millimeter. Primary outcome measures were change in the margin to reflex distance (MRD1) and pupil to brow distance (PTB) with weight on the weighted and unweighted sides for normal and ptosis subjects. RESULTS The weighted eyelid MRD1 decreased linearly with increasing weight. This was true for normal and ptosis subjects. The unweighted eyelid MRD1 increased linearly with increasing weight. This was also the case for both normal and ptosis subjects. With increasing weight, PTB increased linearly on the weighted side. No significant intergroup differences were noted. CONCLUSIONS In normal and ptosis subjects, when external weight on the eyelid is incrementally increased, the weighted eyelid MRD1 decreases, the unweighted eyelid MRD1 increases, and both brows elevate in a linear fashion.
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Affiliation(s)
- Alexandra I Manta
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.
| | - Nicholas J Jackson
- David Geffen School of Medicine, Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, USA
| | - Joshua Dan
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Annie Tran
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, 300 Stein Plaza UCLA, Los Angeles, CA, 9009, USA.,Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, University of California, Los Angeles, CA, USA
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31
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Oculofacial Abstracts. Ophthalmic Plast Reconstr Surg 2023; 39:198-200. [PMID: 36867769 DOI: 10.1097/iop.0000000000002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Affiliation(s)
- John Burroughs
- Springs Aesthetics, Colorado Springs, CO, Colorado, U.S.A
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Tanuj Nakra
- TOC Eye and Face, Austin, TX Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Texas, U.S.A
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, Pennsylvania, U.S.A
| | - Julie Woodward
- Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Ho TC, Maamari RN, Kossler AL, Sears CM, Freitag SK, Reshef ER, Shinder R, Rootman DB, Diniz SB, Kahana A, Schlachter D, Do TH, Kally P, Turner S, Mokhtarzadeh A, Harrison AR, Hwang CJ, Kim HJ, Avila SA, Thomas DA, Magazin M, Wester ST, Lee WW, Clauss KD, Holds JB, Sniegowski M, Compton CJ, Briggs C, Malik AI, Lucarelli MJ, Burkat CN, Patel LG, Couch SM. Outcomes of Patients With Thyroid Eye Disease Partially Treated With Teprotumumab. Ophthalmic Plast Reconstr Surg 2023; 39:150-155. [PMID: 36095848 PMCID: PMC10771969 DOI: 10.1097/iop.0000000000002267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In response to the coronavirus (COVID-19) pandemic, teprotumumab production was temporarily halted with resources diverted toward vaccine production. Many patients who initiated treatment with teprotumumab for thyroid eye disease were forced to deviate from the standard protocol. This study investigates the response of teprotumumab when patients receive fewer than the standard 8-dose regimen. METHODS This observational cross-sectional cohort study included patients from 15 institutions with active or minimal to no clinical activity thyroid eye disease treated with the standard teprotumumab infusion protocol. Patients were included if they had completed at least 1 teprotumumab infusion and had not yet completed all 8 planned infusions. Data were collected before teprotumumab initiation, within 3 weeks of last dose before interruption, and at the visit before teprotumumab reinitiation. The primary outcome measure was reduction in proptosis more than 2 mm. Secondary outcome measures included change in clinical activity score (CAS), extraocular motility restriction, margin reflex distance-1 (MRD1), and reported adverse events. RESULTS The study included 74 patients. Mean age was 57.8 years, and 77% were female. There were 62 active and 12 minimal to no clinical activity patients. Patients completed an average of 4.2 teprotumumab infusions before interruption. A significant mean reduction in proptosis (-2.9 mm in active and -2.8 mm in minimal to no clinical activity patients, P < 0.01) was noted and maintained during interruption. For active patients, a 3.4-point reduction in CAS ( P < 0.01) and reduction in ocular motility restriction ( P < 0.01) were maintained during interruption. CONCLUSIONS Patients partially treated with teprotumumab achieve significant reduction in proptosis, CAS, and extraocular muscle restriction and maintain these improvements through the period of interruption.
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Affiliation(s)
- Tiffany C Ho
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robi N Maamari
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Palo Alto, California, U.S.A
| | - Connie M Sears
- Department of Ophthalmology, Byers Eye Institute, Palo Alto, California, U.S.A
| | - Suzanne K Freitag
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Edith R Reshef
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Alon Kahana
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
- Kahana Oculoplastic & Orbital Surgery, Rochester, Michigan, U.S.A
| | - Dianne Schlachter
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Thai H Do
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Peter Kally
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Sara Turner
- Kahana Oculoplastic & Orbital Surgery, Rochester, Michigan, U.S.A
| | - Ali Mokhtarzadeh
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Andrew R Harrison
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Christopher J Hwang
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Hee Joon Kim
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Sarah A Avila
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Dilip A Thomas
- Department of Ophthalmology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Maja Magazin
- Department of Ophthalmology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Sara T Wester
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Wendy W Lee
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Kevin D Clauss
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery Inc., Des Peres, Missouri, U.S.A
- Departments of Ophthalmology and Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, U.S.A
| | - Matthew Sniegowski
- Department of Ophthalmology, University of Missouri Kansas City, Kansas City, Missouri, U.S.A
| | - Christopher J Compton
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, U.S.A
| | - Christian Briggs
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, U.S.A
| | - Amina I Malik
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Mark J Lucarelli
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Cat N Burkat
- Oculoplastic, Facial Cosmetic & Orbital Surgery, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Luv G Patel
- Retina Center of Texas, Dallas, Texas, U.S.A
| | - Steven M Couch
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Mustak H, Lo C, Cohen LM, Tran A, Almanzor R, McCannel TA, Goldberg RA, Rootman DB. Extrascleral extension of choroidal melanoma after iodine-125 brachytherapy treatment: a case series. Eye (Lond) 2023; 37:249-255. [PMID: 34987200 PMCID: PMC9873620 DOI: 10.1038/s41433-021-01861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES The purpose of this study is to report cases of choroidal melanoma that developed extrascleral tumour recurrence after treatment with iodine-125 brachytherapy. SUBJECTS/METHODS In this single-institution retrospective observational case series, all instances of biopsy-confirmed orbital melanoma after known intraocular melanoma were reviewed. Tumour characteristics, clinical course, time to recurrence, cytogenetics of initial tumour and recurrence, and presence of intraocular recurrence were documented. RESULTS Five cases of orbital melanoma following treatment with plaque radiotherapy are described. Tumour staging was Ia (1), IIa (2), and IIb (2). The primary lesion in four of the five appeared to have undergone complete regression for an average of 2 years, with the orbital melanoma developing after this interval. Recurrence of the intraocular tumour was seen in conjunction with an extrascleral component in two cases. Four cases ultimately underwent enucleation or exenteration; three had evidence of direct extension of tumour through the sclera. Four cases in this series had molecular characteristics associated with high metastatic risk (three patients with monosomy 3, one with BAP1 mutation). CONCLUSIONS High-risk tumour biology may predispose to late appearance of extrascleral melanoma despite optimal treatment and adequate control of the intraocular tumour. Extended follow-up with detailed orbital examination and imaging is recommended for this population.
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Affiliation(s)
- Hamzah Mustak
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher Lo
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Liza M Cohen
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Annie Tran
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert Almanzor
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tara A McCannel
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert A Goldberg
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel B Rootman
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA.
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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Chen T, Roelofs KA, Rootman DB. Allergic conjunctivitis and contact dermatitis following silicone tube intubation. Can J Ophthalmol 2023; 58:e36-e38. [PMID: 35868439 DOI: 10.1016/j.jcjo.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA.
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35
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Danesh K, Cohen LM, Liu Y, Karlin JN, Rootman DB. Systemic eosinophilic disease presenting as dacryoadenitis. Orbit 2023; 42:107-111. [PMID: 34514933 DOI: 10.1080/01676830.2021.1973514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eosinophilic disease with orbital involvement is rare. We present two patients with dacryoadenitis associated with local and systemic eosinophilia. A 32-year-old man presented with episodic dacryoadenitis, lower respiratory inflammation and peripheral eosinophilia. Lung and lacrimal gland biopsies demonstrated eosinophilic infiltrate without granuloma, necrosis, or vasculitis. He improved with oral corticosteroids and Mepolizumab, an IL-5 inhibitor. The second case involved a 33-year-old man who similarly presented with episodic dacryoadenitis, pulmonary inflammation and pain/swelling in the hands and feet. Lacrimal gland biopsy demonstrated a predominantly eosinophilic infiltrate without granuloma or vasculitis. Symptoms improved with oral corticosteroids. Although neither patient was provided a definitive diagnosis, both were determined to have an eosinophilic condition on the spectrum of eosinophilic asthma or eosinophilic granulomatosis with polyangiitis.
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Affiliation(s)
- Kayla Danesh
- University of California Los Angeles, Los Angeles, California, USA
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Yan Liu
- Department of Pathology and Human Anatomy, Loma Linda University Health, Loma Linda, California, USA
| | - Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California, USA
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36
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Roelofs KA, Margines JB, Chen T, Goodyear K, Goldberg RA, Rootman DB. Optimizing Management of Asymmetric Ptosis: A Comparison of Three Posterior Approach Resection Algorithms. Ophthalmic Plast Reconstr Surg 2023; 39:72-75. [PMID: 36095846 DOI: 10.1097/iop.0000000000002246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of 3 resection algorithms in the management of patients with asymmetric ptosis. METHODS Patients undergoing bilateral Muller's muscle-conjunctival resection (MMCR) were identified. Standardized preoperative clinical photographs were examined and margin reflex distance 1 (MRD1) was measured using ImageJ. Patients presenting with ≥1 mm of asymmetry in MRD1 were included. Three groups were identified: variable (4:1 ratio, with the lower side receiving a greater resection), fixed (7 mm resection bilaterally), and tarsectomy (7 mm bilaterally + 1 mm of tarsus resected on the lower preoperative side). Postoperative MRD1 was measured from photographs obtained 3 months after surgery. The primary outcome was postoperative asymmetry. RESULTS A total of 95 patients with a mean age of 71.0 ± 11.0 years were included. There was no significant difference in age ( p = 0.277) or length of follow-up ( p = 0.782) between the groups. Although the fixed tarsectomy group had significantly greater preoperative asymmetry ( p = 0.001), there was no significant difference in postoperative asymmetry ( p = 0.166). On multivariate analysis, preoperative asymmetry was the only significant predictor of postoperative asymmetry ( p < 0.001). Specifically, the surgical group was not a predictor of the primary outcome ( p = 0.723). CONCLUSIONS Resection amount and technique did not predict postoperative outcomes in cases of asymmetric ptosis. This may support the hypothesis that changes in eyelid position and symmetry following MMCR is due to a dynamic system, rather than as a result of purely mechanical forces.
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Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
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37
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Kaneko N, Rootman DB, Takayanagi A, Goldberg R, Duckwiler GR, Tateshima S. Intermittent Orbital Pain due to Hemodynamic Collapse of an Orbital Varix: A Case Report. Case Rep Ophthalmol 2023; 14:353-357. [PMID: 37901639 PMCID: PMC10601828 DOI: 10.1159/000531601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 10/31/2023] Open
Abstract
Orbital varices typically present with symptoms related to dilation or thrombosis. We describe a rare presentation of an orbital varix with pain caused by hemodynamic collapse of the varix. A woman in the third decade presented with position-dependent orbital pain and enophthalmos. She was found to have an intraorbital varix and a separate pterygoid varix. The patient underwent endovascular treatment of the pterygoid varix using coils and sclerosing agents which altered the venous outflow from the orbital varix. The patient had immediate resolution of symptoms after the procedure. Our findings suggest that extraorbital venous outflow abnormalities may be the cause of symptoms in selected cases of orbital varices. By understanding the venous structures on cerebral angiography and treating the extraorbital component, orbital intervention may be avoided, reducing the risk of complications.
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Affiliation(s)
- Naoki Kaneko
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel B. Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, CA, USA
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny Eye Center, Los Angeles, CA, USA
| | - Ariel Takayanagi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, CA, USA
| | - Robert Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Gary R. Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Satoshi Tateshima
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Abstract
A 70-year-old male presented with diplopia and painless proptosis of the left eye for 5 months. Examination showed 6 mm of axial proptosis and restriction of supraduction, abduction and adduction, and mild limitation of infraduction of the left eye. Magnetic resonance imaging demonstrated a large, moderately well-circumscribed intraconal mass in the left lateral orbit, and excisional biopsy was performed. Histopathologic features of mixed fibrous and myxoid areas in a whorl-like pattern and immunohistochemical staining for MUC4 confirmed the diagnosis of low-grade fibromyxoid sarcoma (LGFMS). Next-generation sequencing revealed genetic fusion of EWSR1-CREB3L1. LGFMS is an extremely rare neoplasm with only two prior documented cases of orbital involvement. Here, we report the third case of orbital LGFMS.
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Affiliation(s)
- Angela J Oh
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Pallavi Singh
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Nathan Pirakitikulr
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Kelsey Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Ben J Glasgow
- Division of Ophthalmic Pathology, Jules Stein Eye Institute, and Department of Pathology and Laboratory Medicine, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, USA
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Abstracts. Ophthalmic Plast Reconstr Surg 2022; 38:611-613. [DOI: 10.1097/iop.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Huang S, Juniat V, Satchi K, Cohen LM, Davis G, Rootman DB, McNab A, Selva D. Bilateral lacrimal gland disease: clinical features and outcomes. Eye (Lond) 2022; 36:2163-2171. [PMID: 34725471 PMCID: PMC9582005 DOI: 10.1038/s41433-021-01819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with bilateral lacrimal gland disease are a unique subset of patients where there is a paucity of literature. This presentation often represents systemic disease or malignancy and can cause diagnostic difficulties. We aim to describe the diagnoses and features of bilateral lacrimal gland disease. METHOD Retrospective multi-centre case series involving 115 patients with bilateral lacrimal gland disease from 1995 to 2020. RESULTS 115 patients were included. Their ages ranged from 9 to 85 (mean 47.3 years) with a female predominance (73, 63.5%). The most common category of diagnosis was inflammatory (69, 60%) followed by lymphoproliferative (23, 20%), structural (17, 14.8%) and other conditions (6, 5.2%). The five most common specific diagnoses were IgG4 related disease (20, 17.4%) and idiopathic orbital inflammatory disease (20, 17.4%), lymphoma (16, 13.9%), lacrimal gland prolapse (13, 11.3%), and sarcoidosis (11, 9.6%). Corticosteroid treatment was used most commonly (29, 25.2%) followed by observation (25, 21.7%). At last follow up, the majority of patients had complete resolution, significant improvement with mild residual disease or stable disease without further progression (104, 90.4%). CONCLUSION Bilateral lacrimal disease may be due to a range of aetiologies, most of which are systemic. The most common are inflammatory and lymphoproliferative conditions. Due to the wide range of aetiologies of bilateral lacrimal gland disease, it is extremely difficult to accurately determine a cause based on clinical findings alone, highlighting the vital role of lacrimal gland biopsy in patients presenting with bilateral lacrimal gland disease.
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Affiliation(s)
- Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Valerie Juniat
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Khami Satchi
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, Los Angeles, CA, USA
| | - Garry Davis
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, Los Angeles, CA, USA
| | - Alan McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and The Royal Adelaide Hospital, Adelaide, SA, Australia
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Abstracts. Ophthalmic Plast Reconstr Surg 2022; 38:509-511. [PMID: 36084344 DOI: 10.1097/iop.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Tanuj Nakra
- TOC Eye and Face, Department of Ophthalmology, Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Allan Wulc
- W Cosmetic Surgery, Plymouth Meeting, PA
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Karlin JN, Le C, Rootman DB. Upper eyelid weighting for lagophthalmos results in contralateral upper eyelid elevation. Orbit 2022; 41:464-468. [PMID: 34229537 DOI: 10.1080/01676830.2021.1949725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Upper eyelid weighting decreases lagophthalmos by improving blink dynamics. The effect of weighting on static eyelid position is less well understood. This study describes the effect of upper eyelid weighting on ipsilateral and contralateral upper eyelid position. METHODS Patients with unilateral lagophthalmos who underwent upper eyelid weight implantation were included. Primary outcome measures were ipsilateral and contralateral margin to reflex distance 1 (MRD1), preoperatively and postoperatively. MRD1 symmetry was assessed as a secondary outcome measure. Weight mass was examined as a covariate of MRD1 change. RESULTS 23 patients (16 female, 7 male) met inclusion criteria. After weighting, contralateral MRD1 increased from mean [SD] 2.91 [1.41] mm to 3.77 [1.75] mm (p < .05). Ipsilateral (weighted) MRD1 did not significantly change (2.64 [1.41] mm to 2.40 [1.18] mm, p = .11). Preoperatively, paretic and normal side MRD1 were not different (p = .52). Postoperatively, weighted and unweighted MRD1 were significantly different (p < .05). Weight mass was not a covariate of MRD1 change, neither ipsilateral nor contralateral (p = .76, p = .71, respectively). The proportion of patients with MRD1 asymmetry ≥ 1 mm preoperatively (12/23, 52.2%) did not change following surgery (17/23, 73.9%, p = .12). CONCLUSION Weight insertion led to contralateral eyelid elevation, a manifestation of Hering's law. Weight mass did not impact the magnitude of MRD1 change, and the proportion of patients with MRD1 asymmetry ≥ 1 mm did not change following surgery. These findings may guide surgeons in their preoperative planning and in counseling of patients.
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Affiliation(s)
- Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA
| | - Christina Le
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, California, USA
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Abstract
Importance Given that direct-to-consumer advertising campaigns have the potential to both positively and negatively affect patient care, clinicians would benefit from being conscious of changes in public interest that result from such campaigns. Objective To understand how direct-to-consumer advertising was associated with information-seeking behavior based on Google Trends. Design, Setting, and Participants This descriptive cross-sectional study used Google Trends to examine relative search volumes for thyroid eye disease (TED) from January 1, 2004, to June 30, 2021, in the US. The data for this cross-sectional study were downloaded on October 17, 2021. This study included internet search engine queries originating within the US, as determined by Google Trends. Main Outcomes and Measures Monthly changes in relative search volumes for the terms "thyroid eye disease," "Tepezza," and "teprotumumab." Results From January 1, 2004, through June 30, 2019, searches for TED demonstrated a stable baseline level with a mean (SD) relative search volume of 1.78 (1.25). After US Food and Drug Administration approval of teprotumumab in January 2020, TED searches increased by 25%. After the manufacturer of teprotumumab ran its first national television commercial in December 2020, a 525% increase in TED searches was observed. After a second series of national television advertisements for teprotumumab in May 2021, TED searches increased by 640%. Conclusions and Relevance Findings of this cross-sectional study suggest that direct-to-consumer advertising campaigns for teprotumumab may have been associated with an increase in internet search traffic for TED. Google Trends may serve as a useful tool for measuring the influence of pharmaceutical advertising campaigns on information-seeking behavior in the public. Additional studies are warranted to determine how these changes in public interest correlate with clinical measures, such as referral patterns.
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Affiliation(s)
- Jason C Strawbridge
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Elana A Meer
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Pallavi Singh
- Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California Los Angeles, Los Angeles
| | - Daniel B Rootman
- Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California Los Angeles, Los Angeles
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Lee CM, Asilnejad B, Cohen LM, Roelofs KA, Rootman DB, Khanlou N, Pullarkat ST. Solitary Extramedullary Plasmacytoma of the Lacrimal Sac With Associated Crystal-Storing Histiocytosis. Ophthalmic Plast Reconstr Surg 2022; 38:102-107. [PMID: 34406151 DOI: 10.1097/iop.0000000000002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a rare case of crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma of the lacrimal sac and to review literature on the 2 entities to summarize important diagnostic, management, and prognostic considerations. METHODS A case report of the ophthalmologic presentation, pathology workup, and oncologic management is presented. Literature search with focus on lesions occurring in ophthalmic sites and management guidelines from expert panels and working groups. RESULTS Crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma arose within the lacrimal sac of a previously healthy middle-aged woman and presented as a painless nodule with epiphora. The biopsy tissue showed sheets of crystal-filled histiocytes, interspersed with monoclonal plasma cells and rarely demonstrated plasma cell phagocytosis. Imaging and laboratory studies confirmed the localized nature. CONCLUSIONS Crystal-storing histiocytosis is an uncommon entity in which crystals, most commonly arising from altered immunoglobulins, aggregate within histiocytes and form symptomatic mass lesions. It has been reported in ophthalmic regions in patients with a concurrent lymphoproliferative or plasma cell disorder and can rarely predate a malignancy. The current case is notable because crystal-storing histiocytosis occurs with a localized process, solitary extramedullary plasmacytoma, and presents in an unusual site, the lacrimal sac. Tissue biopsy with multimodal pathological evaluation is necessary to make the diagnosis. Ophthalmologists should recognize that crystal-storing histiocytosis is commonly associated with a hematologic malignancy and, when appropriate, refer the patient for oncologic management. Surveillance may be indicated in cases with no established etiology. Solitary extramedullary plasmacytoma should also be monitored, as a proportion of cases progress to multiple myeloma.
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Affiliation(s)
- Christine M Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brenda Asilnejad
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Roelofs KA, Duckwiler G, Gundlach B, Yoo B, Diniz SB, Cohen LM, Goldberg RA, Rootman DB. Orbital vascular malformations: determining outflow with Valsalva CT angiography. Ophthalmology 2022; 129:590-592. [PMID: 35031439 DOI: 10.1016/j.ophtha.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Distensible orbital vascular malformations with direct outflow to the cavernous sinus tend to show a disproportionate increase in ipsilateral superior ophthalmic vein size on Valsalva CTA and are often located closer to the apex.
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Affiliation(s)
- Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Gary Duckwiler
- Division of Interventional Neuroradiology, Department of Radiology, UCLA Medical Centre, Los Angeles, California, U.S.A
| | - Bradley Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Bryan Yoo
- Division of Diagnostic Neuroradiology, Department of Radiology, UCLA Medical Centre, Los Angeles, California, U.S.A
| | - Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A..
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Cohen LM, Goldberg RA, Rootman DB. Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision. Ophthalmic Plast Reconstr Surg 2021; 38:283-288. [PMID: 34798656 DOI: 10.1097/iop.0000000000002085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Treatment for orbital venolymphatic malformations (VLMs) commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. Each has certain advantages, although it is not clear whether all are effective. The authors characterize the clinical course for a series of patients with distensible orbital venous-dominant VLM treated with sclerotherapy and/or embolization with excision. METHODS In this cross-sectional cohort study, patients affected by distensible orbital venous-dominant VLM presenting to the orbital and ophthalmic plastic surgery service from 2014 to 2020 were identified. Patients were included if they presented with a moderate-flow, distensible venous-dominant malformation associated with Valsalva-related symptoms (e.g., pain, proptosis, and diplopia). RESULTS Six cases were treated with sclerotherapy. Four underwent multiple treatments, with a mean ± SD of 3.5 ± 2.3 (range 1-7). All patients in this group failed to improve or experienced recurrence of symptoms after sclerotherapy. Twelve cases were treated with embolization and excision. Resolution of symptoms in all 12 cases was noted and maintained for a mean of 3.4 ± 2.1 years. There have been no cases of recurrence. Patients treated with sclerotherapy were more likely to experience recurrence of symptoms compared to those treated with embolization and excision (p < 0.001). CONCLUSIONS Treatment of distensible venous-dominant moderate-flow orbital VLM with sclerotherapy may provide temporary improvement in some cases. However, in the medium to long term, recurrence was universal in this series. Embolization with excision appears to provide more definitive management, avoiding recurrence in all cases for a mean follow-up of 3 years.
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Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
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Diniz SB, Cohen LM, Roelofs KA, Rootman DB. Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population. Ophthalmic Plast Reconstr Surg 2021; 37:583-591. [PMID: 33710036 DOI: 10.1097/iop.0000000000001959] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab. METHODS Cross-sectional cohort study including patients with clinical diagnosis of TED who was treated with teprotumumab. The entire cohort was analyzed together and subsequently in clinical subgroups based on stage and grade of disease. Primary outcome measure was change in proptosis ≥2 mm. Secondary outcome measures included change in clinical activity score (CAS), ductions, strabismic deviation, MRD1, and MRD2. Bivariate and multivariate statistics were performed. RESULTS The study included 21 patients. Mean ± SD age was 61.5 ± 12.6 years and 71.4% were female. Reduction in proptosis ≥2 mm was achieved in 71.4% of the sample. Stage and grade were not significant predictors of outcome. Treatment with teprotumumab resulted in a 2.5 ± 1.8 mm reduction of proptosis (P < 0.001), 2.2 ± 1.4 reduction in CAS (P < 0.001), and 16.9 ± 19.3 degree improvement in extraocular motility (P < 0.001). There were no significant differences for change in CAS, proptosis, ductions, or MRD2 between different grades and stages of disease. Total strabismus and MRD1 improvement were greater in the active stage of disease (P < 0.05). Three cases of dysthyroid optic neuropathy, refractory to methylprednisolone therapy improved after initiation of teprotumumab. CONCLUSIONS Treatment of TED with teprotumumab in a heterogeneous patient population is associated with improvement in proptosis, extraocular motility, and CAS. Patients beyond those defined in the clinical trials, including those affected by stable stage, milder grade, and vision-threatening TED may benefit from this therapy. There are, however, limits on the overall efficacy of this medication in the management of certain physical characteristics in TED including eyelid position and strabismus.
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Affiliation(s)
- Stefania B Diniz
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Abstract
PURPOSE To describe the effect of spaceflight on upper eyelid and brow position. MATERIALS AND METHODS Images of astronauts on earth and in space were collected from a National Aeronautics and Space Administration image library. For each astronaut, front facing portraits captured within a 5-year period were obtained. At least 6 photos were collected per astronaut, 3 taken on earth, and 3 in zero gravity. Measurements from the center of the pupil to the upper eyelid margin (MRD1) and center of the pupil to the inferior eyebrow margin [pupil-to-brow (PTB)] were performed digitally for each image and averaged for each condition and each individual. Differences in mean MRD1 and PTB were assessed to illustrate the effects of zero gravity on eyelid and eyebrow position respectively. Linear-mixed effects modeling, analysis of variance and post hoc power analysis were performed. RESULTS One hundred and twelve photographs (55 earth, 57 space) from 18 astronauts (4 women, 14 men; mean age 45.9 years) were retrieved. Zero gravity resulted in a mean PTB increase of 3.7 mm (p < 0.01) but did not result in significant change in MRD1 (p = 0.21). Post hoc power analysis of the measured MRD1 difference was performed by simulation. At an MRD1 difference of 0.5 mm, the probability of a type II error is 2.6%, equivalent to a beta power of 97.4%. Thus, we can be 97.4% confident that a difference in MRD of 0.5 mm or greater would be detected. CONCLUSIONS While spaceflight led to significant elevation of PTB, it did not consistently alter MRD1. As such, the brow and eyelid appear to be independently regulated with respect to gravitational changes.
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Affiliation(s)
- Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California
| | | | - Stephanie Stacy
- Department of Statistics, University of California, Los Angeles, CA
| | | | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California
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Burroughs J, Hwang CJ, Nakra T, Rootman DB, Wulc A, Woodward J. Aesthetic Abstracts. Ophthalmic Plast Reconstr Surg 2021; 37:394-396. [PMID: 37590907 DOI: 10.1097/iop.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Catherine J Hwang
- Orbital & Oculofacial Plastic Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tanuj Nakra
- TOC Eye and Face, Austin, Texas
- Department of Ophthalmology, Dell Medical School, The University of Texas at Austin
| | - Daniel B Rootman
- Department of Ophthalmology, Jules Stein Eye Institute, UCLA, Los Angeles, California
| | - Allan Wulc
- Private Practice, W Cosmetic Surgery, Plymouth Meeting, Pennsylvania
| | - Julie Woodward
- Chief Oculofacial Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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Karlin JN, Ahankoob N, Rootman DB. Multiple Arterial Vascular Anomalies in the Periorbital, Paranasal, and Intracranial Spaces Treated With Systemic Bevacizumab. J Craniofac Surg 2021; 32:e768-e771. [PMID: 34224454 DOI: 10.1097/scs.0000000000007764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Arteriovenous malformations of the orbit are rare congenital hamartomas defined by a direct connection between the arterial and venous systems without an intervening capillary bed. Treatment can be challenging, as these lesions are anatomically complex, often involve multiple locations, and have a tendency to recur. A multidisciplinary approach is typically required, involving endovascular and surgical teams. The authors present a case of a 33-year-old man with a complex, recurrent orbital arteriovenous malformations in the context of wider head and neck vascular anomaly syndrome involving the paranasal sinuses, deep facial tissues, and intracranial spaces. The complex and evolving clinical manifestations of this disease are presented with emphasis on the interdependence of the anomalies and biologic management strategies.
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Affiliation(s)
- Justin N Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, CA Rocky Vista University College of Osteopathic Medicine, Parker, CO
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